The Case I Can’t Forget is a weekly series that hears from the people working at the coalface of public service about the cases they have carried with them throughout their careers.
This time, former junior doctor Barney Gilbert pulls apart the complex social factors that contributed to a patient’s mental health problems.
If you have a story you’d like to tell, email firstname.lastname@example.org
Doctors see all kinds of things. They see all types of people. It’s this variety that makes our work rewarding, challenging, and shifts our perception of normal. But every so often there comes a case you can’t quite shake, one you can’t forget.
I met James* in 2016 while working as the liaison psychiatry doctor at Wexham Park Hospital. A gaunt man in his mid 40s, James was living with the twin burdens of chronic liver disease and advanced MS, with mobility extending no more than 50 yards. The reason I’d been asked to see him wasn’t so much for his physical symptoms but for his mental health. James’ mother had suddenly died from a heart attack and, given he already suffered from severe anxiety, it was clear he would need support.
We began trying to help James manage his condition with regular reviews and a trial of antidepressant medication over the ensuing weeks, but these tried and tested methods were not breaking through. We adjusted his medication dose and checked for other health conditions, but still faced the same frustrating lack of progress. As a doctor you’re trained for, and used to, helping people get better or alleviating at least part of their physical or mental pain. It’s hard when you’re confronted with the limit of medicine’s abilities, but what’s worse is when you don’t even know why.
I was having lunch one day in the hospital courtyard when I saw James there too. I approached him and we got talking, giving me the chance to find out more about the man behind this brutal medical record. From then on, whenever I saw James at lunch we would talk and I began to learn more about his story – and the reason he wasn’t getting any better. It unravelled that James was in fact homeless and was now extremely anxious about being discharged; he didn’t have anywhere to go back to, let alone a place to recover, when he left hospital. On top of this, his application for a community counselling group had just been rejected. It was hardly surprising that his mental health was stuck at rock bottom.
In the UK we can be naive in assuming that if you’re in trouble or facing difficulty, we’ve got a system that will get you the help you need. But James was finding big holes in our social care and welfare nets, which were meant to catch people in his situation. As a medical professional, and as a person, I didn’t want to stand by and watch him fall through the gaps. After much wrangling, I managed to secure James a place in a community rehab centre, which would accept him after leaving hospital. This wasn’t heroic work at all; I had only grown close with James by chance and I knew I was just one of countless doctors and public sector workers trying to hold the net together.
Months later I got a call from a number I didn’t recognise: it turned out to be James. He’d asked for mine before leaving for the rehab centre and was ringing to thank me for what I’d done in helping him get a place at the rehab centre. Though I was pleased to be able to help him, it didn’t take away from the heaviness that had settled in my stomach after learning James’ story. I hadn’t recognised his number but I certainly hadn’t forgotten him. Years later I still haven’t. His is the face I can’t forget.
What made James and his case stick so much in my mind weren’t his symptoms – as a doctor you become used to the effects of illness – or even his kindness, so much as the level to which various systems had failed him. As a doctor, I believe the best but have seen the worst in our health and social care system and know that, tragically, James is not an anomaly. Resources across the piece are under pressure, facing the perfect storm of budgets cuts and increasing strain, and hampered by silos, communication breakdowns, and poor integration between services. It’s all too often that the most in need end up in the care of the NHS, where clinicians work under pressure to plaster up the worst wounds. The human body works because our nerves, when wired and firing right, exist in intricate and efficient networks, and energy is channelled to where it’s needed. The same principle must be applied to our health and social care system.
It’s easy to talk about our broken and overloaded public systems and, fatally, to decide that’s the way they’re always going to be. For me, James’ case highlighted the cracks which people in vulnerable situations too often fall through, but connection and humanity will never disappear. My work as a doctor has shown me not only where the system can fail but also where it can flourish. It’s this hope for the future which I choose to remember.
*name changed for privacy
The Case I Can’t Forget is a weekly series from HuffPost UK that hears from those on the frontline of public service about the cases they have carried with them throughout their careers. If you have a story you’d like to tell, email email@example.com.